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1+: Understanding Metal Levels

Jun 01, 2015

With so many options to consider in the Health Insurance Marketplace (also called the exchange), deciding on the best health care plan can be confusing. But the Affordable Care Act (ACA or health care reform law) made it easier to compare plans by requiring insurers to offer plans that fall into one of four levels of coverage for individual and small group plans. These coverage categories use metal levels ─ bronze, silver, gold or platinum ─ to arrange plans into tiers, based on how they cover the costs of care.

What the levels mean
These tiers have nothing to do with the quality or amount of care a person gets. That’s because all plans must include a core set of benefits, called essential health benefits (EHBs), as defined by health care reform law. Some of these EHBs include coverage for emergency room care, hospital stays, maternity and newborn care, prescription drugs and preventive care. But plans in each tier pay different amounts of the total costs of a person’s care. This takes into account premiums and cost-share amounts, such as deductibles, copayments, coinsurance, and out-of-pocket limits.

For example, bronze plans have the lowest monthly premiums, but the members’ cost-share responsibility in this tier is higher when they get health care services. Platinum plans have the highest monthly premiums, but members pay lower cost share amounts.

Four coverage levels 
Here’s how each tier breaks down to offer four coverage levels for people to choose from, based on their budgets and health care needs:

The coverage level impacts not only premiums but also how much the member pays for things like hospital visits or prescription drugs. Beyond the required essential health benefits, different plans may offer coverage for other services as well. This means not all bronze-level plans are the same. They’re offered by different companies that can choose to cover different services at different costs. Typically, provider networks also vary. 

How to advise your clients
So what should you tell your clients to think about when considering a metal-level plan in the Marketplace?

For more details, visit Anthem's health care reform website.

For questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

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